Article

Psychosocial Treatments for Multiple Unexplained Physical Symptoms: A Review of the Literature

Department of Psychiatry, Robert Wood Johnson Medical School-University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey 08854, USA.
Psychosomatic Medicine (Impact Factor: 4.09). 11/2002; 64(6):939-50. DOI: 10.1097/01.PSY.0000024231.11538.8F
Source: PubMed

ABSTRACT Patients presenting with multiple medically unexplained physical symptoms, termed polysymptomatic somatizers, often incur excessive healthcare charges and fail to respond to standard medical treatment. The present article reviews the literature assessing the efficacy of psychosocial treatments for polysymptomatic somatizers.
Relevant articles were identified by scanning Medline and PsychLit. Thirty-four randomized, controlled studies were located. Whenever possible results from each study were transformed into effect sizes. An analysis of the efficacy of the psychotherapeutic approaches is provided.
Various psychosocial interventions have been investigated with polysymptomatic somatizers. Although the majority of studies suggest psychosocial treatments benefit this population, the literature is tarnished by methodological shortcomings. Effect sizes are modest at best. Long-term improvement has been demonstrated in fewer than one-quarter of the trials.
Although seemingly beneficial, psychosocial treatments have not yet been shown to have a lasting and clinically meaningful influence on the physical complaints of polysymptomatic somatizers.

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    • "That is, " given that a) the reliance on medically unexplained symptoms as a key factor for such diagnoses is inherently problematic, b) the diagnoses are not used by clinicians, c) patients find them very objectionable, d) clinicians find these diagnoses unclear, and e) there are highly discrepant prevalence estimates using various criteria…a number of changes in this important area of psychiatric diagnosis " have been proposed for the DSM-V ( " Justification " 2011). The literature in recent years tracking researchers' thinking makes for fascinating reading, in particular the growing recognition that the somatizing patient is not simply " making herself sick " through some hysterical reaction to stress but may be experiencing a variety of problems, from stress caused by being ill to undiagnosed/unacknowledged psychological trauma, to a heightened physiological sensitivity to stress and pain affecting body and mind simultaneously and synergistically (Allen et al. 2002, 940; Rief and Isaac 2007, 143). However, the revised diagnostic criteria, while motivated by a desire to be more inclusive and more sensitive to patient experiences, are still rather subtle and nebulous; how long it will take for these changes to filter through the system of medical education and into popular culture is difficult to predict. "
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    • "However, most of these studies merely compare CBT treatments with medical treatment as usual, or with WLC (Allen et al. 2002; Kroenke 2007; Looper and Kirmayer 2002; Nezu et al. 2001). At the same time, Allen et al. (2002) pointed out that unexplained physical symptoms may be ameliorated by many active or control treatments, for example the patient's expectation of improvement or the attention of a healthcare provider. For this reason we conducted an RCT with progressive muscle relaxation (PMR) as a control condition. "
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    • "The failure to provide medical explanations for such symptoms joined with the patients' disturbed psychic background (which is intimately involved in the disease outcome) is conducive to the heavy demands put upon the health care system [38, 39]. An excessive amount of money is spent for the management of patients complaining of multiple MUPS (‘polysymptomatic somatizers’), in whom the standard medical treatment is doomed to failure from the start and in whom the psychosocial interventions, although apparently beneficial, have not been proven to have a lasting and clinically significant impact [40]. "
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